Outcomes of Endoscopic Therapy for Luminal Strictures in Crohn’s Disease

Shivashankar, Raina; Varayil, Jithinraj Edakkanambeth; Harmsen, William S.; Faubion, William A.; Song, Louis M. Wong Kee; Schroeder, Kenneth W.; Kisiel, John B.; Loftus, Edward V.; Prabhu, Nayantara Coelho

doi:10.1093/ibd/izy049

Cited by 33 publications

(38 citation statements)

References 16 publications

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“…Reports of the usefulness of balloon dilatation for stenosis in CD cases are increasing. Shivashankar R noted that endoscopic stricture dilatation in CD was safe and effective, and that the most common stricture location was ileocolonic anastomosis [12]. Ding NS as well reported that endoscopic balloon dilatation of an anastomotic stricture in Crohn's cases is safe and effective over the long term [13].…”

Section: Discussionmentioning

confidence: 99%

Localization of recurrent lesions ileocolic resection for Crohn's disease

Ikeuchi

Uchino

Bando

et al. 2020

Preprint

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Background Crohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following ileocolic resection (ICR). The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion. Methods We examined cases of surgery with ICR initially performed at our institution. Those with a simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded. Results A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4–27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n = 31), 29.0% (n = 9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n = 5) in the group with residual disease (n = 14). Conclusions Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.

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Section: Discussionmentioning

confidence: 99%

Localization of recurrent lesions ileocolic resection for Crohn's disease

Ikeuchi

Uchino

Bando

et al. 2020

Preprint

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“…3 However, intra-stricture triamcinolone injection after EBD in adult CD strictures yielded a worse outcome. 4 In authors' clinical practice, intralesional injection has not been part of routine care. As such, the routine use of intralesional corticosteroids after EBD is not recommended.…”

Section: Techniquesmentioning

confidence: 99%

“…In a separate study of 135 patients with primary strictures, 66 patients (35.7%) undergoing EBD later needed salvage surgery. 4 Lee et al, 8 followed CD patients who underwent EBD for a median follow-up of 134.8 months, 26.7% of patients required redilation. In another study, 4 including 286 CD patients managed with EBD, the cumulative probability of the need for a second dilation following the index procedure was 33.6% at 1 year (95% CI, 25.9%-38.7%), 53.9% at 3 years (95% CI, 45.9%-61.2%), and 60.2% at 5 years (95% CI, 51.4%-67.5%).…”

Section: Efficacy Of Ebd In Case Seriesmentioning

confidence: 99%

“…3,[9][10][11][12] Several metanalyses confirm the efficacy and safety of EBD in the treatment of CD strictures. 4,13,14 A systematic review and analysis of data sets of 676 patients also showed that EBD has a high rate of short and long-term efficacy with acceptable rates of complication. In this study, a stricture length of less than 5 cm was favorably associated with a surgery-free survival.…”

Section: Efficacy Of Ebd In Case Seriesmentioning

confidence: 99%

“…The parameters listed in the nomogram included symptomatic disease, a longer time interval from last surgery, and radiographic proximal bowel dilation. 4 Patients with those risk factors may benefit from upfront surgery. In contrast, those without these factors may be treated with EBD first.…”

Section: Selection Of Endoscopic Therapymentioning

confidence: 99%

See 2 more Smart Citations

Update of endoscopic management of Crohn’s disease strictures

Pokala

Shen

2020

Intest Res

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Therapeutic strategies for stricturing Crohn’s disease in childhood: a systematic review

et al. 2021

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Purpose Childhood stricturing Crohn’s disease (CD) has significant morbidity. Interventions including resection, stricturoplasty and endoscopic balloon dilatation (EBD) are often required. Optimal intervention modality and timing, and use of adjuvant medical therapies, remains unclear. We aim to review the therapies used in paediatric stricturing CD. Methods A systematic review in accordance with PRISMA was performed (PROSPERO: CRD42020164464). Demographics, stricture features, interventions and outcomes were extracted. Results Fourteen studies were selected, including 177 patients (183 strictures). Strictures presented at 40.6 months (range 14–108) following CD diagnosis. Medical therapy was used in 142 patients for an average of 20.4 months (2–36), with a complete response in 11 (8%). Interventions were undertaken in 138 patients: 53 (38%) resections, 39 (28%) stricturoplasties, and 17 (12%) EBD. Complications occurred in 11% of resections, versus 15% stricturoplasties, versus 6% EBD (p = 0.223). At a median follow-up of 1.9 years (interquartile range 1.2–2.4) pooled stricture recurrence was 22%. Resection had 9% recurrence, versus 38% stricturoplasty, versus 47% EBD (p < 0.001). Conclusions Resection is associated with a low incidence of recurrence and complications. There remains a paucity of evidence regarding adjuvant medical therapy and the role of EBD. We propose a minimum reported dataset for interventions in paediatric stricturing CD.

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Outcomes of Endoscopic Therapy for Luminal Strictures in Crohn’s Disease

Cited by 33 publications

References 16 publications

Localization of recurrent lesions ileocolic resection for Crohn's disease

Localization of recurrent lesions ileocolic resection for Crohn's disease

Update of endoscopic management of Crohn’s disease strictures

Therapeutic strategies for stricturing Crohn’s disease in childhood: a systematic review

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